Does
Vitamin D and Calcium Affect the Incidence of
Premenstrual Syndrome
.........................................................................................................................
Dr Elena Al-Quraan, JBFM
Dr Ghassan Al-Quraan, JBOG
Correspondence:
Dr Elena Al-Quraan, JBFM
Department of Family Medicine
Ministry of Health / Jordan
E-mail: quraangh@yahoo.com
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ABSTRACT
Objective
To evaluate the importance of using Calcium
and vitamin D in order to lower the incidence
of Premenstrual syndrome.
Material and
methods Retrospective surveys of cases
of Premenstrual syndrome in the period
from the 1st of January 2004 to the 31st
of December 2005. All cases were collected
from the Gynecological Department at Prince
Rashid Bin Al-Hassan military hospital
in the north of Jordan as well as Princess
Haya Al Hussein military hospital in the
south. Over this period the selected patients
for this study had been given a food-frequency
questionnaire, to compare dietary data
with the incidence of Premenstrual syndrome.
Results
Five hundred and fifty cases had entered
this survey over a period of two years,
divided into two groups. There was significant
difference between the two groups; North
group (n= 470) and the South one (n= 80).
The analyses of the questionnaire revealed
a 30 -40 % lower risk in developing PMS
in women with the highest intake of calcium
and vitamin D from dietary sources (south
group).
Conclusion
The high intake of Vitamin D & Calcium
is effective in reducing the incidence
of Premenstrual syndrome.
Key words
PMS, Vitamin D, Calcium.
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Hippocrates1
mentioned Premenstrual syndrome as early as
the fourth century BC, and physicians in Victorian
times were aware of menstrual madness, hysteria
and ovarian mania. Its recognition by Frank2
makes it a nineteenth-century event, and he
was the first to describe the premenstrual tension
in 1931. In 1953 Green and Dalton3
extended the definition to 'premenstrual syndrome'.
Many doctors do not believe there is such a
condition as Premenstrual Syndrome (PMS), and
consequently fail to recognize and treat it,
although PMS is widely recognized as one of
the most common disorders in women. This disorder
is characterized by the cyclic recurrence of
symptoms during the luteal phase of the menstrual
cycle as seen in Table (1)4,5,6,
and is manifested by emotional and physical
symptoms in the second part of the menstrual
cycle, which subsides by the beginning of the
menstrual period7. It is estimated
that at least 75% of women experience premenstrual
symptoms8, and up to 40% experience
symptoms severe enough to affect life9.
The etiology of PMS remains unknown and may
be complex and multifactorial. The role of ovarian
hormones is unclear, but symptoms are often
improved when ovulation is suppressed10.
Hormonal causes such as excessive circulating
oestrogen, increased or decreased levels of
progesterone or an imbalance between them has
been proposed11. The current consensus
is that PMS is the result of non-hormonal, biological
and environmental changes in susceptible women.
The management of PMS is often frustrating
for both patients and physicians. Initially,
all patients with PMS should be offered non-pharmacological
therapy12. These non-pharmacological
interventions for PMS include patient education,
supportive therapy and behavioral changes4,5,6.
Therapies for PMS vary in their efficacy and
risk of adverse events. Some therapies, such
as eating a healthy diet, are known to have
a variety of health benefits with very low risk
of adverse events, and should be recommended
to virtually all women. Pharmacologic therapies
carry a greater risk of adverse events, and
this must be considered when selecting such
therapy, and should be only offered to patients
with persistent symptoms of PMS.
Aim and objective:
To evaluate the effect of dietary calcium and
vitamin D in the incidence of PMS.
A retrospective survey was
carried out in two hospitals of the Royal Medical
Services in Jordan (Prince Rashid Bin Al-Hassan
military hospital in the north of Jordan as
well as in Princess Haya Al Hussein military
hospital in the far south); in the period between
the 1st of January 2004 until 31 of December
2005. All collected data was taken from hospital
records. Every woman who entered this survey
was registered in hospital record files as having
mild, moderate or severe PMS. Women with PMS,
were distributed according to their residency
and in this study according to climate (sunny
weather in south Badia), tradition and food
habits (milk and cheese) and different types
of job. Jordan was divided, theoretically, into
two parts: north and south. Over a period of
24 months, the selected patients for the study
had been given a food-frequency questionnaire,
to compare dietary intake data between the two
parts (north and south) with the incidence of
PMS.
During the study period
five hundred and fifty cases had entered this
survey. They had been distributed according
to their residency in Jordan (North, South).
There was significant difference between the
North group (n= 470) and the South group (n=
80) in the incidence of PMS (93% in the North
compared with 7% in the South). The analyses
of food frequency questionnaire revealed that
women with the highest intake of Calcium and
Vitamin D from dietary sources (in the South
of Jordan) had a 30 -40 % decreased risk of
developing PMS than women with the lowest intake
(in the North).
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Table 1 Common
symptoms of Premenstrual Syndrome4,5,6 |
| Behavioural
symptomsFatigue, insomnia, dizziness, changes
in sexual interest, food cravings or overeating. |
| Psychologic
symptomsIrritability, anger, depressed mood,
crying and tearfulness, anxiety, tension,
mood swings, lack of concentration, forgetfulness,
restlessness, loneliness, decreased self-esteem. |
| Physical
symptomsHeadaches, breast tenderness and
swelling, back pain, abdominal pain and
bloating, weight gain, water retention,
swelling of extremities, nausea, muscle
and joint pain. |
The normal menstrual
cycle is characterized by physiologic fluctuations
of pituitary gonadotropins, ovarian steroid
hormones and also their influence on the levels
of micronutrients; specifically calcium and
vitamin D. There is convincing evidence that
PMS is related to hormonal fluctuations of the
menstrual cycle and it occurs only in women
with ovulatory cycles. PMS does not occur prepubertally
or at menopause13. Research suggests
that a variety of nutrients may have an important
role in the phase-related mood and behavioral
disturbances of the PMS and there is scientific
evidence specifically for calcium and vitamin
D, supporting their cyclic fluctuations during
the phase of menstrual cycle. Estrogen regulates
calcium metabolism, intestinal calcium absorption
and parathyroid gene expression and secretion,
triggering fluctuations across the menstrual
cycle14.
Alterations in calcium homeostasis (hypocalcaemia
and hypercalcaemia) have long been associated
with many affective disorders in mood15
and such symptoms as depression, anxiety and
the dysphoric states make the relation between
PMS and hypocalcaemia remarkable. Evidence to
date indicates that women with PMS have an underlying
calcium dysregulation and vitamin D deficiency,
and calcium has been shown to relieve both the
physical and emotional symptoms associated with
PMS.
Three clinical trials demonstrated the efficacy
of calcium treatment. In 1989, a randomized,
double-blind crossover trial was conducted to
assess the effectiveness of calcium in women
with PMS16. At the end of the trial,
73% of the women cited global improvement of
symptomatology on calcium compared to placebo.
In 1993, Penland et al conducted a metabolic
study of calcium and manganese nutrition in
ten women with premenstrual and menstrual distress
symptomatology17. The high dietary
calcium intake in the amount of 1336 mg per
day was found to benefit mood, behaviour, and
pain and water retention symptoms significantly
during the menstrual cycle. In 1998, a prospective,
multicenter, randomized double-blind placebo
controlled parallel-group clinical trial was
conducted in women with moderate to severe PMS
to determine the efficacy of calcium in symptom
reduction18. By the third treatment
cycle, calcium effectively resulted in an overall
48% reduction in total symptom scores. Recently
an article was published citing a study conducted
by the university of Massachusetts in Amherst
that stated women with a higher intake of calcium
and vitamin D are at lower risk for the anxiety,
depression, headaches and abdominal cramps associated
with premenstrual syndrome.
In this study, we found
that a diet high in calcium and vitamin D is
not only a simple and effective measure in reducing
the risk of Premenstrual Syndrome, but may help
to prevent its initial development.
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